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Nudging and informed consent: a duo that doesn’t mix

What is nudging? We can try to define this term as follows: « Nudging: persuading someone to do something, gradually or by flattery; gently encouraging someone to do something »(1). Why talk about it in a context of political and health crisis? More importantly, what does this have to do with informed consent?

These thoughts and questions came to me through reading the reports of a group of psychology experts who are advising the government on the management of the current crisis and who publish reports, all available online(2). I first welcomed the existence of such a group, given the disastrous impacts of this crisis management on the mental health of the entire population. I thought it was an excellent decision to have psychologists mobilize and put mental health on the agenda as an urgent concern. I was quite surprised to see that this group included a significant number of social psychologists. Surprised because mental health is not the main concern of this branch of psychology. So what do the social psychologists in this group advise on? This became clearer when I read the report on « Prerequisites for Vaccination », and it is on this report that I base this article. 

This report analyses the social behaviour of the population and what needs to be done to encourage people to be vaccinated and to reach the famous 70% of vaccination coverage, the relevance of which I will not debate in the context of this article. Suffice it to say that there is no consensus in the scientific community(3). These words caught my eye:  » encourage people to get vaccinated.  » What did they mean by that? The report leaves little room for doubt: it is openly about developing a framework that will encourage and push people to get vaccinated, and a whole host of advice is given to achieve this objective of 70% of people vaccinated. Various techniques are used to achieve this end, which leads me to talk about the famous « nudging », which is in the background of this report. While this term is not explicitly mentioned in this particular report, it is mentioned in the report entitled « Synthesis Report of the Psychology and Corona Expert Panel » under recommendation number 7(4).

Here is another definition, from a scientific article cited in the report:  » Nudges can be defined as interventions that steer people in a certain direction but also allow them to make their own choices « (5). Nudging is therefore a technique that aims to influence and direct the behavior of a person or a group of people in a certain direction and that, in the end, leaves him the choice. This last point is a paradox for reasons developed below. Furthermore, what this definition does not explicitly mention, although it is implied, is that nudging is done without the targeted person or group being aware of it, which is a crucial aspect. It is interesting to note that the article from which this definition is taken refers to the vaccination of children in schools and day-care centers, which is totally different from the covid vaccine and the current vaccination campaign. 

The difference is fundamental because the covid vaccines, despite the single thought conveyed by the media, are not the object of a scientific consensus on the fact that they are the only and unique solution to get out of this crisis, which will take place only when we will have reached these famous 70% of vaccinated people, a figure whose scientific basis is very uncertain and which does not take into account the naturally acquired immunity, however very effective(6). The fact that we are being massively steered in this direction is therefore not based on solid scientific knowledge, which is contrary to the situation described in the article by Giubilini and collaborators, quoted above, which cannot therefore logically be taken as an example to be followed in the case at hand.

Concerning the vaccination campaign for covid, an important problem arises: the fact of manipulating people in order to incite them to be vaccinated (because that is what it is all about, the reading of the report of the psychologists’ experts leaves little room for reasonable doubt), deprives them of their informed consent. Indeed, how can we talk about « informed consent » when we have been manipulated into making this decision? Have we really chosen? Do we really have all the information at our disposal to make a decision that really belongs to us, without outside influence? Or has our consent been « manufactured »? When we are pushed without our knowledge in a precise direction, using nudging, and then we are informed that in the end we have a choice, this is very similar to the manipulation technique called « the illusion of freedom », very well described in the scientific literature, notably by Joule and Beauvois(7). In short, to manipulate a person’s choice in a predetermined direction, it is a matter of giving him the illusion that he has the choice without any influence, when in fact everything is done to make his choice go in this very precise direction. This technique is extremely effective.

The paradox with living in a democracy is challenging, and raises many profound questions: is this the society we want to live in? Can we call a society « democracy » when the government knowingly pushes us in a direction without our knowledge and without our having a say? What values are conveyed by these practices? How is this different from a form of « social training »? What room is left for debate, for transparency and honesty, for questioning, for humility, for the plurality of opinions and the right to express them? Have we definitively given up on all that, and, in the same breath, given up on education and pedagogy, in favor of marketing techniques? Have the consequences of such a form of governance been considered? Are we in a utilitarian drift of « the end justifies the means »? And what can we say about the science that develops these techniques to put them at the service of politics without any consultation with the public? What impact will this have on citizens’ trust in science and scientists? This last question particularly surprises me because it was the subject of the last magazine « Imagine tomorrow’s world: Science in the age of suspicion ».(8) This is all the more surprising given that some of the members of this panel of psychologists participated in the writing of this very article.

Can we call a society « democracy » when the government knowingly pushes us in a direction without our knowledge and without our having a say? What values are conveyed by these practices? How is this different from a form of « social training »?

Despite these many issues, none are mentioned in the reports of the psychologists, who do not seem to care much about the consequences of their advice or the values they convey. Apparently, as long as you achieve the goal, the rest doesn’t matter. This is a formal application of « the end justifies the means ».

To conclude, I am not advocating the banning or total condemnation of nudging. I have a major problem with the fact that all this has not been the subject of any societal debate, that these techniques are used without the knowledge of the entire population and that there are no safeguards against the obvious abuses that could occur when using them. What happens if you get the goal wrong? What would happen if we massively influence a whole population in a direction that ultimately does more harm than good? Shouldn’t the objectives be discussed with those directly concerned before being pursued? I think that all this should be openly discussed, and that the citizens — at least a part of them, the whole being of course illusory — should be actively involved. 

I think that our democracies have shown all their weaknesses during this crisis and that they must evolve, reinvent themselves and go towards a much more direct form by favoring a much more active participation of the population, at the risk of being replaced by systems that have left dark traces in history. I am deeply convinced that citizens will be enthusiastic and motivated to regain a much more tangible power of action on society than the mere fact of voting, which could ultimately be excellent for mental health, by promoting the feeling of power of action and avoiding sinking into defeatism and pessimism. 

In view of the current crisis and the ongoing climate crisis, it is more than desirable, and this is an understatement, to avoid cultivating a feeling of fatalism, which has never solved anything. At this point, we no longer have that luxury.

Ludwig Hemeleers

Notes et références
  1. To nudge : coax or gently encourage (someone) to do something. To coax : persuade (someone) gradually or by flattery to do something. Oxford Dictionnary of English, third edition, 2010, pp. 1217 and 333
  2. https://www.uppcf.be/psychologie-et-corona
  3. https://covidrationnel.be/2021/05/11/note-technique-vaccins-contre-la-covid-19-base-de-preuves-et-consentement-eclaire/
  4. Ibid, référence 2
  5. « Nudges can be defined as interventions that steer people in particular directions but that also allow them to go their own way », Giubilini et al., 2019, Nudging immunity : the case for vaccinating children in school and day care by default, HEC Forum (2019) 31 : 325–344, https://doi.org/10.1007/s10730-019–09383‑7
  6. Ibid, note 3 et aussi : https://www.kairospresse.be/deux-ex-vaccina/. Pour l’efficacité de l’immunité naturelle, voir https://www.nature.com/articles/s41586-021–03647‑4 pour l’article scientifique, https://www.nature.com/articles/d41586-021–01442‑9?utm_source=Nature+Briefing&utm_campaign=6642113fdd-briefing-dy-20210527&utm_medium=email&utm_term=0_c9dfd39373-6642113fdd-45689842 pour l’article de presse
  7. Robert-Vincent Joule et Jean-Léon Beauvois, « Petit traité de manipulation à l’usage des honnêtes gens », Presses Universitaires de Grenoble, 1987
  8. Imagine Demain le Monde, n°143, « La science à l’ère du soupçon », mars-avril 2021, P.26–47

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